nep-hea New Economics Papers
on Health Economics
Issue of 2015‒01‒31
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Workers Compensation Insurance: Incentive Effects of Experience Rating on Work-related Health and Safety By Pascale Lengagne
  2. Advancing the Development and Implementation of Behavioral Health Quality Measures (In Focus Brief) By Jonathan Brown ; Sarah Hudson Scholle ; Melissa Azur
  3. A matter of life and death? Hospital distance and quality of care: evidence from emergency hospital closures and myocardial infarctions By Avdic, Danie
  4. Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts? By David W. Brown ; Amanda E. Kowalski ; Ithai Z. Lurie
  5. Improving Health Outcomes and Health Care in India By Isabelle Joumard ; Ankit Kumar
  6. Analysis of Catastrophic Health Financing by Key Institutions By Caballes, Alvin B.
  7. Assessing the Feasibility of Public-Private Partnerships in Health in the Philippines By Banzon, Eduardo P. ; Lucero, J.A. ; Ho, B.L. ; Puyat, M.E. ; Factor, P.A. ; Young, F.J.
  8. Social health insurance improves women’s healthcare use: Evidence from Indonesia By Samarakoon, Shanika ; Parinduri, Rasyad
  9. Vertical Transmission of Overweight: Evidence From English Adoptees By Joan Costa-Font ; Mireia Jofre-Bonet ; Julian Le Grand
  10. Tuberculosis and Diabetes Mellitus Control and Care: A Rapid Situational Analysis for Planning a Coordinated Program Response By Serrano, Grace Kathleen T. ; Baja, Emmanuel S. ; Lansang, Mary Ann D. ; Alejandria, Marissa M. ; Castillo-Carandang, Nina ; Itable, Jill R.
  11. Health Capital and Human Capital as Explanations for Health-Related Wage Disparities By Donna Gilleskie Denise Hoffman
  12. Social interactions in inappropriate behavior for childbirth services: Theory and evidence from the Italian hospital sector By Guccio, C.; ; Lisi, D.;
  13. Out-of-pocket expenditures for pharmaceuticals: Lessons from the Austrian household budget survey By Alice Sanwald ; Engelbert Theurl
  14. Estimating Regression-Based Medical Care Expenditure Indexes for Medicare Advantage Enrollees By Anne E. Hall
  15. Budget - a perfect tool for performance evaluation health system? By Iacob, Constanta ; Constantin, Camelia
  16. Pricing in the Market for Anticancer Drugs By David H. Howard ; Peter B. Bach ; Ernst R. Berndt ; Rena M. Conti
  17. Do changes in reimbursement fees affect hospital prioritization? By Melberg, Hans Olav ; Pedersen, Kine
  18. Solo Practitioners Remain Important Contributors to Primary Care By Deborah N. Peikes Stacy Berg Dale
  19. Employer-Sim Microsimulation Model: Model Development and Application to Estimation of Tax Subsidies to Health Insurance By G. Edward Miller ; Thomas M. Selden ; Jessica S. Banthin

  1. By: Pascale Lengagne (IRDES Institut de recherche et documentation en économie de la santé )
    Abstract: This article examines Workers Compensation Insurance experience rating premiums setting, a common financial incentive tool existing in several countries. Premiums paid by firms are experience rated, which may encourage them to reduce work-related injuries and disabilities. This article provides a literature review on effects of experience rating on work-related health and safety, and empirical results on the French jurisdiction, using sectorial data from industry and construction sectors in 2005. Results are consistent with the hypothesis that this policy tool is a lever that contributes to improve working conditions and reduce work-related injuries rates.
    Keywords: Workers’ Compensation, experience rating, working conditions, work-related injuries.
    JEL: J28 I13 I18
    Date: 2015–01
  2. By: Jonathan Brown ; Sarah Hudson Scholle ; Melissa Azur
    Keywords: Behavioral Health , Quality Measures
    JEL: I
    Date: 2015–01–14
  3. By: Avdic, Danie (CINCH-Health Economics Research Center )
    Abstract: The article analyzes to which extent residential proximity from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI). The critical time aspect in AMI treatment provides an ideal application for evaluating this proximity-outcome hypothesis. Previous studies have encountered empirical difficulties relating to potential endogenous health-based spatial sorting of involved agents and data limitations on out-of-hospital mortality. Using policy-induced variation in hospital distance, arising from plausibly exogenous emergency hospital closures in the highly regulated Swedish health care sector, and data on all AMI deaths in Sweden over two decades, estimation results show a clear robust and gradually declining probability of surviving an AMI of about two percentage points (three percent) per additional ten kilometers distance from a hospital. The results further show that spatial sorting and sample selection from out-of-hospital mortality are likely to significantly attenuate the distance effect unless accounted for.
    Keywords: Myocardial infarction; geographical access; hospital closures; health policy; spatial sorting; self-selection; out-of-hospital mortality; causal effect
    JEL: C23 I14 I18 R41
    Date: 2015–01–13
  4. By: David W. Brown (Office of Tax Analysis, US Treasury ); Amanda E. Kowalski (Cowles Foundation, Yale University ); Ithai Z. Lurie (Office of Tax Analysis, US Treasury )
    Abstract: We use administrative data from the IRS to examine the long-term impact of childhood Medicaid expansions. We use eligibility variation by cohort and state that we can relate to outcomes graphically. We find that children with greater Medicaid eligibility paid more in cumulative taxes by age 28. They collected less in EITC payments, and the women had higher cumulative wages. Our estimates imply that the government will recoup 56 cents of each dollar spent on childhood Medicaid by the time these children reach age 60. This return does not include estimated private gains from increased college attendance and decreased mortality.
    Keywords: Health insurance, Simulated instrument, Mortality, EITC
    JEL: H2 I1 I38
    Date: 2015–01
  5. By: Isabelle Joumard ; Ankit Kumar
    Abstract: With India’s low life expectancy largely reflecting deaths from preventable diseases, the most significant gains in health would come from population-wide preventive measures. Access to public health care services varies substantially, resulting in many people turning to private-sector providers who mainly serve those who can pay. While government has scaled up public health services, more health professionals and public health care spending will be needed to ensure broad and adequate health-care coverage. Priority should be given to high impact primary health care services. For more resources to translate into better services, the management of public health care services needs to improve. The private sector can be drawn upon more extensively, but should also be obliged to meet basic quality standards. Améliorer la santé et l'accès aux soins de tous en Inde. La faible espérance de vie en Inde s’expliquant largement par la mortalité liée à des maladies évitables, les gains les plus notables au plan sanitaire seront réalisés grâce à des mesures de prévention généralisées. L’accès aux services de santé publique est très variable et une part importante de la population se tourne vers les prestataires du secteur privé, qui servent essentiellement une population plus aisée. Si les autorités ont renforcé les services de santé publique, il faudra plus de professionnels de santé et plus de dépenses publiques de santé pour assurer une couverture sanitaire adéquate. Il conviendrait de donner la priorité aux services de soins primaires, à fort impact. Il conviendrait également d’améliorer la gestion des services publics de santé pour garantir une meilleure qualité de ces services par rapport aux ressources investies. Le secteur privé pourrait être davantage mis à contribution, mais devrait également être tenu de respecter des normes de qualité minimales.
    Keywords: health, health professionals, RSBY, India, public and private health insurance, RSBY, assurance santé privée, Inde, assurance santé publique, santé
    JEL: H51 I13 I15 I18
    Date: 2015–01–08
  6. By: Caballes, Alvin B.
    Abstract: Financial protection of patients is considered a key component of health systems, and has been a consistent policy goal of the Department of Health. Of paramount importance in this regard are catastrophic health expenditures, which can severely restrict the access to much-needed services, contribute to (further) impoverishment, or result in both, for the affected patients and families. This study was undertaken to determine the institutional mechanisms for addressing these expenditures, and develop a framework to improve the existing arrangements. Focus group discussions (FGDs) and consultations were conducted for this study. Based on the inputs from the FGDs, the following recommendations are made: (1) A new definition of catastrophic health expenditures is proposed thus: "The situation applies when a patient’s condition requires medical interventions which are life or limb saving and determined to be clinically appropriate and cost effective, but attendant expenses are beyond the actual means of the patient (or family) at the time of need, whether due to time or resource constraints"; (2) The burden of financial support will be assigned to specific agencies, depending on care requirements (e.g., facilities to absorb costs of urgent care to be subsequently reimbursed by third-party payers; PhilHealth and PCSO to attend to intensive care; and PhilHealth and DSWD to finance chronic care); and (3) A dedicated unit will be established to further develop relevant policies and strategies for the integrated financing of catastrophic health expenditures.
    Keywords: Philippines, universal health care (UHC), catastrophic health expenditure, financial risk protection
    Date: 2014
  7. By: Banzon, Eduardo P. ; Lucero, J.A. ; Ho, B.L. ; Puyat, M.E. ; Factor, P.A. ; Young, F.J.
    Abstract: The government has decided to utilize the public-private partnership (PPP) program to help improve access to quality hospitals and health care facilities. This paper looks into the feasibility of implementing PPPs in the health sector. Review of literature, key informant interviews, and focus group discussions were conducted for the study. The Philippine hospital system was reviewed using five performance criteria, namely, improved health care access, equity, and quality, operating with maximum efficiency, and ensuring sustainability followed by the development of an assessment framework; the application of the said framework; and policy and program implementation recommendations for health PPPs. In order to improve the feasibility of PPPs in the health sector, it is recommended that the government use public-private investment partnerships as the definition for health PPPs, encourage public policy discussions on PPP and its relation to socioeconomic development, and develop a comprehensive communications program for PPPs. It needs to rectify shortcomings in previous PPPs and ensure absolute transparency and accountability in the entire PPP process. There is a need to amend the legal framework to ensure coherence of health PPPs. It should conduct joint capacity-building initiatives and develop and enforce an evidence-based decisionmaking process for PPPs. It needs to strengthen implementation of monitoring and evaluation and utilize the health system indicators in evaluation of PPPs. Finally, it should ensure universal PhilHealth membership to attract private sector.
    Keywords: Philippines, health, public-private partnership (PPP), public-private investment partnerships, public-private interactions
    Date: 2014
  8. By: Samarakoon, Shanika ; Parinduri, Rasyad
    Abstract: To improve the poor’s access to healthcare services, the Indonesian government introduced Askeskin, a subsidized social health insurance for the poor. We examine the effects of this social health insurance on women’s use of healthcare—maternal, preventive, and curative healthcare—services. Using propensity- score- and difference-in-differences matching strategies, we find the insurance increases the use of public facilities for maternal healthcare, discourages the use of midwives’ services, and increases the use of contraception; it does not seem to increase the use of preventive and curative care, however.
    Keywords: Social health Insurance; maternal healthcare; women’s preventive and curative healthcare; Indonesia; South East Asia
    JEL: I11 I12 I13 I15
    Date: 2015–01
  9. By: Joan Costa-Font ; Mireia Jofre-Bonet ; Julian Le Grand
    Abstract: We examine the vertical transmission of overweight drawing upon a sample of English children, both adopted and non-adopted, and their families. Our results suggest strong evidence of an intergenerational association of overweight among adoptees, indicating transmission through cultural factors. We find that, when both adoptive parents are overweight, the likelihood of an adopted child being overweight is between 10% and 20% higher than when they are not. We also find that the cultural transmission of overweight is not aggravated by having a full-time working mother, so do not confirm the existence of a female labour market participation penalty on child overweight among adoptees. Overall, our findings, despite subject to data limitations, are robust to a battery of robustness checks, specification and sample selection corrections.
    Keywords: Vertical transmission, cultural transmission, overweight, children, natural parents, Body Mass Index, sample selection
    JEL: I18 D13 Z1
    Date: 2015–01
  10. By: Serrano, Grace Kathleen T. ; Baja, Emmanuel S. ; Lansang, Mary Ann D. ; Alejandria, Marissa M. ; Castillo-Carandang, Nina ; Itable, Jill R.
    Abstract: Tuberculosis (TB) remains one of the leading killers among bacterial diseases worldwide. In the Philippines, the prevalence of culture-positive TB is estimated to be 5 per 1000 and that for sputum smear-positive pulmonary TB is 2 per 1000 based on the 2007 National Prevalence Survey. In addition, the prevalence of metabolic syndrome among Filipinos is 5 percent or approximately 5 million people have diabetes (DM) in the Philippines. With the Philippines being endemic for TB, compounded by an upward trend of DM, there is a need to jointly address this tandem disease interaction. This study aims to mount a coordinated response to TB/DM with the following expectations: 1) improve the case detection rate for TB, 2) facilitate early management among patients, and 3) prevent a significant number of severe disease and deaths. Mixed methods are used to achieve the objectives including a systematic review and gray literature to estimate the magnitude of co-morbidity with TB and DM, records review specifically medical records on clinical charts of patients, cross-sectional survey on knowledge, attitudes, and practices of health care providers on TB/DM screening and care, focus group discussions comprising of program managers and technical advisors of the National Tuberculosis Program, and costing exercise on bidirectional screening of TB in diabetic patients and vice versa. Given the government`s commitment to the nationwide control of TB, the underexplored frontier of TB among diabetic patients can be among the stretch goals toward increased case detection, management and prevention efforts. Likewise, the increasing prevalence of diabetes in the country and the associated risk of TB transmission in a TB-endemic population suggest the need for raising awareness on the need for TB screening. However, there is a body of programmatic and operational research questions to answer before an integrated approach to bidirectional screening can actually be implemented.
    Keywords: Philippines, diabetes mellitus, tuberculosis, coordinated program response
    Date: 2014
  11. By: Donna Gilleskie Denise Hoffman
    Abstract: We use a dynamic modeling strategy to evaluate two potential avenues through which health differences generate a wage gap: directly through reductions in health capital and indirectly through employment transitions that reduce human capital (specifically, occupation and employer tenure). Our results suggest that male workers with a moderate disability are 23 percent more likely to change occupations or employers than nondisabled men. Compared to those who do not make a transition, workers with a moderate disability who change occupations and employers experience an immediate $0.30 decline in hourly wages on top of a $0.57 decline associated with the disability onset.
    Keywords: Health Capital, Human Capital, Wage Disparities
    JEL: I J
    Date: 2014–09–22
  12. By: Guccio, C.; ; Lisi, D.;
    Abstract: Over the last decades the role of social interactions has become increasingly important in the economic discussion and, by now, it is acknowledged that the interaction across agents can produce both positive and negative effects. In this paper we evaluate the role of social interactions in the hospital sector using the large incidence of caesarean section, usually considered an inappropriate outcome in the childbirth service. In doing so, we lay out a theoretical model of hospitals’ behavior where the effect of peers’ behavior emerges by the simple sharing of the same institutional authority. Then, using the risk adjusted cesarean section rate of a large panel of Italian hospitals, we empirically investigate whether the behavior of each hospital is affected by the behavior of hospitals within the same region, after controlling for demand, supply and financial factors. In particular, we perform our empirical test employing both peer effects estimate and the spatial econometric approach, exploiting the panel dimension of our data. Both estimates show a significant and strong presence of peer effects among hospitals, robust to sensitivity analyses. We interpret this evidence as a large presence of constraint interactions in the healthcare sector, with important implications for the healthcare policy.
    Keywords: social interactions; peer effects; caesarian section; spatial econometrics;
    JEL: I11 C31
    Date: 2014–12
  13. By: Alice Sanwald ; Engelbert Theurl
    Abstract: BACKGROUND: Paying pharmaceuticals out-of-pocket is an important source of financing pharmaceutical consumption. Only limited empirical knowledge is available on the determinants of these expenditures. OBJECTIVES: In this paper we analyze which characteristics of private households influence out-of-pocket pharmaceutical expenditure (OOPPE) in Austria. DESIGN & METHODS: We use cross-sectional information on OOPPE and on household characteristics provided by the Austrian household budget survey 2009/10. We split pharmaceutical expenditures into the two components prescription fees and over-the-counter (OTC) expenditures. To adjust for the specific characteristics of the data we compare different econometric approaches: two-part model, hurdle model, generalized linear model, zero-inflated negative binomial regression model. FINDINGS: The finally selected econometric approaches give a quite consistent picture. The probability of expenditures of both types is strongly influenced by the household structure. It increases with age, doctoral visits and the presence of a female householder. The education level and income only increase the probability of OTC-pharmaceuticals. The level of OTC-expenditures remains widely unexplained while the household structure and age influences the expenditures for prescription fees. Insurance characteristics of private households either private or public play a minor role in explaining the expenditure levels in all specifications. This refers to a homogenous and comprehensive provision of pharmaceuticals in the public part of the Austrian health care system. CONCLUSIONS: The paper gives useful insights into the determinants of pharmaceutical expenditures of private households and supplements the previous research which focuses on the individual level.
    Keywords: Out-of-pocket pharmaceutical expenditures, consumer survey, two part model, generalized linear model, hurdle model, zero-inflated negative binomial model
    JEL: I1
    Date: 2015–01
  14. By: Anne E. Hall (Bureau of Economic Analysis )
    Date: 2014–11
  15. By: Iacob, Constanta ; Constantin, Camelia
    Abstract: As in any field, and the health system, it is necessary to know the path to follow, step which involves developing a budget of income and expenditure and the subsequent budgetary control. Theoretically, content and methodology of developing a budget of income and expenses are based on the same principles universally applicable, but the complexity of the work undertaken leads to the distinction between two types of budgets or medical office budget and the budget of public hospitals. Subjecting attention budgetary practice in connection with the work carried out funding sources in the health system, we note a reversal of principles, namely, not expenses are those that generate future benefits but rather predictable revenues allowed a certain level of expenditure which put questioned the role of budget performance evaluation in health care.
    Keywords: budget, budgetary practice, functions, budget control
    JEL: H61 I15 M41
    Date: 2015–01–19
  16. By: David H. Howard ; Peter B. Bach ; Ernst R. Berndt ; Rena M. Conti
    Abstract: Drugs like bevacizumab ($50,000 per treatment episode) and ipilimumab ($120,000 per episode) have fueled the perception that the launch prices of anticancer drugs are increasing over time. Using an original dataset of 58 anticancer drugs approved between 1995 and 2013, we find that launch prices, adjusted for inflation and drugs’ survival benefits, increased by 10%, or about $8,500, per year. Although physicians are not penalized for prescribing costly drugs, they may be reluctant to prescribe drugs with prices that exceed subjective standards of fairness. Manufacturers may set higher launch prices over time as standards evolve. Pricing trends may also reflect manufacturers’ response to expansions in the 340B Drug Pricing Program, which requires manufacturers to provide steep discounts to eligible providers.
    JEL: I1
    Date: 2015–01
  17. By: Melberg, Hans Olav (Department of Health Management and Health Economics ); Pedersen, Kine (Department of Health Management and Health Economics )
    Abstract: It has been argued that activity based payment systems make hospitals focus on the diagnostic groups that are most profitable given costs and reimbursement rates. This article tests the hypothesis by exploring the relationship between changes in the DRG reimbursement rates and changes in the number of registered treatment episodes for all DRG-codes and hospitals in Norway between 2006 and 2013. The results show that hospitals increase the number of admissions in a diagnostic group when the reimbursement rate is increased, and decrease it (or increase it less) when DRG-rates are reduced. Across all treatments, during all years included in our primary analysis, the increase in volume is about four times as large for DRG-categories with increased reimbursement compared to DRGs with decreased reimbursement rates. However, the results also show that the number of treatment episodes in a diagnostic category is affected by many other factors in addition to the economic incentives.
    Keywords: DRG; activity based payment system; distortions; effect of financial incentives; priorities
    JEL: I10 I12 I18
    Date: 2015–01–08
  18. By: Deborah N. Peikes Stacy Berg Dale
    Keywords: Practitioners, Primary Care
    JEL: I
    Date: 2015–01–30
  19. By: G. Edward Miller ; Thomas M. Selden ; Jessica S. Banthin
    Abstract: Employment-related health coverage is the predominant form of health insurance in the nonelderly, US population. Developing sound policies regarding the tax treatment of employer-sponsored insurance requires detailed information on the insurance benefits offered by employers as well as detailed information on the characteristics of employees and their familes. Unfortunately, no nationally representative data set contains all of the necessary elements. This paper describes the development of the Employer-Sim model which models tax-based health policies by using data on workers from the Medical Expenditure Panel Survey Household Component (MEPS HC) to form synthetic workforces for each establishment in the Medical Expenditure Panel Survey Insurance Component (MEPS IC). This paper describes the application of Employer-Sim to estimating tax subsidies to employer-sponsored health insurance and presents estimates of the cost and indcidence of the subsidy for 2008. The paper concludes by discussing other potential applications of the Employer-Sim model.
    Date: 2014–12

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